Sex is not much fun when it hurts. About 15 to 20 percent of women in the United States report having pain during intercourse, and yet this problem often makes women feel alone. Unlike a backache or tennis elbow, it’s not something you can easily share with friends or colleagues.
It’s not unusual for a woman to consult various health professionals, only to have the physical exam reveal nothing unusual. Some women are even told that “the pain must be in your head.” Luckily, this approach is starting to disappear. The National Vulvodynia Association (nva.org) offers resources for patients and health providers. There has been an increased interest lately in researching what causes the pain and in getting to the bottom of how it can be treated. As a consequence, medical professionals are becoming more aware of the complexity of the issue, and are getting better training.
So what does “vulvodynia” mean? “Dynia” is the Greek word for pain, so it simply means “pain of the vulva.” The vulva is the outside area of a woman’s genitals, which includes the two layers of skin-folds (the labia majora and minora) surrounding the vaginal opening. Some women experience pain at the entry of their vagina, some feel a deeper pain, and some cannot tell where exactly it hurts the most. The sensations range from burning, stabbing, dull, to sharp pain. The underlying reasons include treatable skin conditions, vulvar vestibulitis, vaginismus, pelvic floor disorders, hormone abnormalities, endometriosis, pelvic inflammatory disease, and chronic pelvic pain, just to name a few.
Italian sexologist Dr. Alessandra Graziottin is one of the leading experts in the world and she has a wealth of information on her website alessandragraziottin.it. If her information is too technical for you, this should sum it up: There is help out there. Don’t give up. If you are having pain during sex, talk to your regular gynecologic health provider about it. Depending on your specific situation, there may be various treatment options for you. We are fortunate in Charlottesville to have many experienced health professionals associated with both Martha Jefferson and UVA hospitals who can help you. If you are a UVA student, you can get excellent help at the UVA Student Health Center, where they frequently treat sexual pain problems. The UVA Pain Management Center also specializes in vulvar pain disorders (243-5678).
Women with this type of pain often tense up their pelvic floor muscles. These are the muscles that surround your vagina and help keep your pelvic organs in place. Women with tense pelvic floor muscles and sexual pain can benefit from pelvic floor physical therapy, which is provided by the local Passages PT (passagespt.com/about.htm)
Other treatment options, such as medication and sex counseling, are often combined with physical therapy. I find it particularly helpful to include the woman’s sexual partner in the discussions. It often helps the partner to learn about the causes of the pain, and more important, what the various treatment options are, and how to lend support.
And I tell my clients with pain problems to focus less on intercourse. Avoid what hurts and explore anything that’s pleasurable. By doing so, many couples discover that making love without vaginal penetration can be an equally rewarding experience. Sex therapist Marty Klein has written an entire book on the subject: Let me count the ways. Discovering great sex without intercourse.
